Massage Therapy Consent and Release Form
By signing below, you agree to the following:
I voluntarily request and consent to receiving massage therapy.
I understand that the massage service offered is for the purpose of general wellness, stress reduction, and
relief of muscular tension only.
I do not have any injuries or conditions that prevent me from receiving massage therapy. I understand the
importance of informing my massage therapist of all medical conditions and medications that I am taking,
and that there may be additional risks based on my physical condition.
If I experience any pain or discomfort, I will immediately inform my therapist so that the pressure or
techniques used can be adjusted to my comfort level. I will not hold my massage therapist responsible for
any pain or discomfort I experience during or after the session.
I understand the risks associated with massage therapy include, but are not limited to:
Superficial bruising
Short-term muscle soreness
Exacerbation of undiscovered injury
I have not received a positive test for coronavirus within the past 14 days, and currently have no symptoms.
I do not have any contagious conditions that may put my massage therapist or other clients at risk.
I understand that I or the massage therapist may terminate the session at any time.
I have been given the opportunity to ask questions about massage therapy and my questions have been
answered.
I have been advised of the policies and procedures pertaining to massage and I understand these policies.
Information regarding massage in general, benefits, contraindications of massage, and possible alternative
therapies have been explained to me. I further understand that massage therapy is not a substitute for a
medical examination or treatment, and that I should see a physician or other qualified health specialist for any
mental or physical ailment of which I am aware. I understand that massage therapists do not diagnose illness
or disease, and nothing said during the massage should be construed as such. My consent is informed and
voluntary and I understand that I may withdraw my consent at any time except for actions already taken.
By signing this form I give my consent to proceed with the massage service as outlined above.
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Client Name (Please Print) Date
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Client Signature
